Leprosy Mailing List – November 20, 2015
Ref.: (LML) Draft WHO Leprosy Strategy 2016-2020
From: Sunil Dogra, Chandigarh, India
Dear Colleagues,
Please go through a very recent publication on the issue of U-MDT in Indian Dermatology Online Journal .
Global leprosy program: Does it need uniform-multi-drug therapy now? | p. 425 |
P Narasimha Rao, Sunil Dogra, Sujai Suneetha
DOI:10.4103/2229-5178.169735
Indian Dermatol Online J [serial online] 2015 [cited 2015 Nov 18];6:425-7. Available from: http://www.idoj.in/text.asp?2015/6/6/425/169735
It highlights concerns and shortcomings of proposed U MDT which makes us think - is there any compelling REASON & EVIDENCE to implement UMDT. - Are we doing it to improve compliance - we are aware of high drop out rates with 6 months ATT in TB and did cure rate in MB cases improved significantly on reducing MDT MBR from 2 year to 1 year ?
- World Health authorities can not afford 1 year MDT MB supply for remaining few lakhs of patients ?
- Even if results of UMDT trial are not discouraging at the moment, what are we going to lose by continuing current FDT MDT MBR (1 year) ?
- Is present leprosy classification for treatment is difficult for general health care staff to follow - if so why not single (U) MDT MBR of 1 year duration for all cases of leprosy. ?
- Do we have an effective and functional referral system in place in present setting of integration of leprosy services with GHS for patients who will suffer from reactions and deformities after RFT in 6 months of starting treatment ?
- In the absence of SSS in routine practice - diagnosis of relapse and resistance will be questionable.
Are we not going to implement UMDT at the cost of risk of under treating MB cases especially with high BI. Will it not lead to possibility of secondary drug resistance in such MB cases and hence Primary in those infected later. ? High relapse rate with UMDT is very certain on long term (>7-10 years follow up) as we had seen even when MDT was given for 2 years.
With warm regards
|
Dr Sunil Dogra MD DNB FRCP (London)
Additional Professor
Department of Dermatology
Postgraduate Institute of Medical Education & Research (PGIMER)
Chandigarh, India.
sundogra@hotmail.com
Vice President: Indian Association of Leprologists (IAL)
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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